Massachusetts Child Custody FormMassachusetts Child Custody Form
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COMPLAINT FOR SUPPORTCUSTODY-VISITATION PURSUANT TO
G.L. c. 209C

Commonwealth of Massachusetts
The Trial Court
Probate and Family Court

Docket No.

Division
, Plaintiff
V.
, Defendant

1. Plaintiff, who resides at
(State)

(Zip)

the

mother

(Address Line)

, is
father

(Apt, Unit, No. etc.)

(City/Town)

of a child born out of wedlock.

a child born out of wedlock.
the

guardian

custodian of a child born out of wedlock.

the

parent

personal representative

of the

mother

father

of a child born out of wedlock.

Plaintiff is:
Department of Children and Families

an agency licensed under G.L. c. 28A

Department of Revenue

2. The child who is the subject of this complaint is:
M.I.

First Name

Date of Birth

Last Name

who resides at
(Address Line)

3. Defendant, who resides at
( State)

(Address Line)

is the

( Zip)

(Apt, Unit, No. etc.)

mother

father

(City/Town)

(State)

(Apt, Unit, No. etc.)

(Zip)

(City/Town)

of the above-named child who was born out of wedlock.